Painful sores in the mouth and throat are one of the most common adverse side effects caused by radiation therapy, which is a mainstay of treatment for most cancers of the head and neck.

This condition, known as oral mucositis, frequently causes quality-of-life issues such as difficulty swallowing or eating and interrupted sleep, and often necessitates prescription of opioids or other analgesics for pain control.

New research from Roswell Park Comprehensive Cancer Center, presented at the American Association for Cancer Research (AACR) Annual Meeting 2019 in Atlanta, reports that administering radiation treatments in the morning as opposed to later in the day can significantly reduce severity of mucositis and its related impacts.

“Acute oral mucositis is not only extremely painful for patients, it also interferes with their care and recovery in a number of ways, from impaired nutritional intake and treatment delays to higher chance of infection, hospitalisation and use of opioids, which comes with a host of additional side effects and risks,” says senior author Anurag Singh, MD, Professor of Oncology and Director of Radiation Research in Roswell Park’s Department of Radiation Medicine.

“And while these factors double the costs of supportive care in comparison to milder cases, the few prevention and treatment options available for this condition have limited efficacy and/or supporting evidence.”

Hypothesising that timing of radiation treatments could be impacting the severity of mucositis, the team studied patterns of oral mucositis in 190 head neck cancer patients treated at Roswell Park.

They found a significant association between radiation treatment timing and oral mucositis severity in head and neck cancer patients.

“We found that the severity of oral mucositis increased as the time at which radiation treatments were administered got later, peaking at early afternoon,” says Dr. Singh.

“Our findings highlight a simple and easily implementable solution for reducing severe oral mucositis in head and neck cancer patients, and one that may have significant clinical and quality-of-life benefits for patients.”

The authors believe this is the first study to find significant variation of oral mucositis severity by treatment timing.

“Identifying an optimal time of a day for radiotherapy may substantially prevent severe oral mucositis in head and neck cancer patients,” says first author Fangyi Gu, MD, ScD, Assistant Professor of Oncology in the Department of Cancer Prevention and Control at Roswell Park.

“Further studies are worthwhile to confirm our findings, and to find optimal treatment times for individual patients.”

Source: Roswell Park Comprehensive Cancer Center